Associação entre a técnica de contagem de carboidratos e o crescimento estatural de indivíduos com diabetes mellitus tipo 1: dados de estudo multicêntrico brasileiro

Abstract

Type 1 diabetes mellitus (T1DM) can interfere in the growth of affected children and adolescents since adequate development in this age group can be compromised by glycemic control. Some studies associate a good glycemic control with better final stature in children and adolescents with T1DM. In addition, the use of carbohydrate counting has been shown to be associated with improved glycemic control and dietary adherence. However, to date, there are few studies evaluating the relationship between dietary therapy used and growth in patients with diabetes. Objective: To evaluate the association between the carbohydrate counting technique and the growth of T1DM patients. Methods: This was a cross-sectional study, which included 3,591 participants from the Brazilian Type 1 Study group (BrazDiab1), the main Brazilian population-based multicenter study of T1DM, conducted from 2008 to 2010. Participants with chronological age <19 years were selected from the database. For data analysis, the patients were categorized into two types of dietary therapies, according to the use or not of carbohydrate counting. Regarding adherence to the diet, individuals who reported a minimum percentage of 80% were considered adequate. Patients with T1DM with stature z score <0 were considered as below the average of the general population and subjects with z score <2 were considered as having short stature. For analysis of weight, height and body mass index (BMI) the data were transformed into height/age Z score (Z H/A) and BMI Z score (Z BMI). Results: A total of 1,441 participants were selected, 56% (n=807) female, mean age of 12.1 ± 4.0 years, disease duration of 5.0 ± 3.7 years. A total of 34.6% (n=499) performed the carbohydrate counting technique. Among those who counted carbohydrates, 59.9% (n=299) were female versus (vs) 53.7% (n=506) among those who did not (p = 0.02). Among the patients who counted carbohydrates, 64.7% (n=323) stated dietary adherence greater than or equal to 80% vs 51% (n=477) among those who did not count (p = <0.01). Regarding the findings of the variables related to growth, the mean Z BMI was -0.09 ± 0.20 in both dietary therapies (p = 0.57). For Z A / I, the mean was 0.15 ± 1.21 in those who counted carbohydrates and 0.02 ± 1.29 in those who did not (p = 0.39). The findings regarding adequate adherence to the diet (≥ 80%) showed no impact on the growth outcome. There was no association between carbohydrate counting and z height scores < - 2 (OR = 0.62, 95% CI: 0.34-1.14). However, when the dependent variable was a height score <0, it was observed that the individuals that counted had a protection factor of 0.77 (95% CI: 0.60-0.97) in relation to the individuals who did not practice carbohydrate counting. Conclusion: a possible association between the carbohydrate counting technique and the growth of individuals with T1DM was observed. Considering the inadequate stature, both the diabetic individuals below average in relation to the general population and those with short stature, our data showed a lower prevalence among the group that performed carbohydrate counting, suggesting a potential association between carbohydrate counting and linear growth in this population.